Rehabilitation outcomes in cognitively impaired patients admitted to skilled nursing facilities from the community

Objective: To examine the outcomes of patients with varying levels of cognitive impairment who received rehabilitation in skilled nursing facilities (SNFs). Design: A retrospective analysis of the records of people admitted to SNFs for rehabilitation. Setting: Seven SNFs in Colorado. Participants: Community-dwelling persons (N=7159), 65 years of age and older, admitted for rehabilitation after a hospitalization or decline in function between May 1998 and May 2002. Interventions: Not applicable. Main Outcome Measures: Cognitive impairment was assessed using a 4-level categorization of the FIM instrument cognitive score at admission. Functional gain was measured using the FIM. Community discharge was measured as the proportion of patients discharged to home, board and care, or assisted living facility. Rehabilitation progress was measured as the number of FIM points gained per day. Results: Significant functional gains were made during rehabilitation in motor and cognitive FIM scores, regardless of cognitive impairment. The most cognitively impaired patients required more rehabilitation intervention, achieved less FIM gain, and were less likely to be discharged to the community. The strongest predictors of FIM gain were the amount of therapy hours and admission cognitive FIM score. The strongest predictors of discharge to the community were the discharge total FIM score and age. The strongest predictors of adequate rehabilitation progress were medical complexity and admission cognitive FIM score. Conclusions: Patients with cognitive impairment were able to recover function with rehabilitation intervention. Patients with a more serious cognitive impairment received more rehabilitation intervention than patients with less impairment. Outcomes were predicted by admission and rehabilitation measures that were qualitatively different from other discharge outcomes. Health care professionals need to consider these factors as they create a rehabilitation plan of care for patients with cognitive impairment. (C) 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.